International survey of parental and patient perspectives on emerging adrenaline devices for community-based management of anaphylaxis: An EAACI task force report.

INTRODUCTION

Intranasal adrenaline has been approved in multiple countries for anaphylaxis treatment, based primarily on pharmacokinetic/pharmacodynamic comparisons to adrenaline autoinjectors (AAIs).

AIM: To assess patient and caregiver perspectives regarding emerging non-injectable adrenaline routes.

METHODS

Online survey of adults and caregivers of children with food allergy prescribed AAIs, with international dissemination supported by the European Academy of Allergy and Clinical Immunology (February-April 2025).

RESULTS

We analyzed 542 responses from caregivers and 224 from adults with food allergy. Effectiveness of adrenaline nasal spray (ANS) compared to AAI was rated "extremely important" by 78% of caregivers and 71% of adults. 48% of caregivers and 42% of adults were "extremely worried" that ANS may not work as well as AAI, and 50% and 44% (respectively) that it may not work well enough. Compared with AAI, respondents were less worried about ANS being painful or difficult to carry, and about fear/embarrassment around use, but more worried about side effects and knowing how to use it. Most anticipated being more comfortable using ANS than AAI, and over half anticipated earlier use during anaphylaxis. Only 17.2% of caregivers and 23.2% of adults preferred to be prescribed ANS only. There was interest in sublingual adrenaline due to portability and reduced needle-related burden, but confidence depended on comparable speed/effectiveness and feasibility during reactions.

CONCLUSIONS

Non-injectable adrenaline is attractive to caregivers and adults, and may improve willingness to carry and use adrenaline. However, demand for evidence of effectiveness, safety, and real-world feasibility is high, highlighting important information needs for shared decision-making.